Fractures of the femoral neck, for example, may be treated by intramedullary nailing. In such treatments, a nail for intramedullary nailing typically comprises at least one bore hole for receiving a bone screw. The nail is generally introduced in the longitudinal direction of the femur, wherein the bone screw laterally extends at a certain angle with respect to the neck of the femur when the bone screw is received within the at least one bore hole. A certain problem of the surgeon is to predict the future or implanted position of such a nail or implant or parts thereof. In the past, the operator has acted in a trial and error manner to obtain a more or less optimum position of the implant. However, this may lead to a longer duration of the operation which may lead to higher stress for the patient. Further, for each trial, at least one X-ray image (e.g. a fluoroshot) is generally necessary in order to check the present position of the implant in order to evaluate its position.
“Computer assisted surgery for dynamic hip screw, using Surgix©, a novel intraoperative guiding system” by Amir Herman et al. in The International Journal of Medical Robotics and Computer Assisted Surgery, Dec. 29, 2008; Volume 5, pages 45-50, describes a computer assisted surgery system using an image analysis technology in order to measure three-dimensional distances, visualize implant templates, and view a guided trajectory on standard fluoroscopy. A guiding system combines a set of X-ray opaque markers incorporated into transparent hardware as an aiming, positioning, and referring device. This device is attached to a guide wire. Fluoroscopic images are obtained by the surgeon and then are processed by an image processing engine which calculates a three-dimensional orientation relative to a C-arm and a drill trajectory in the image.
Further, a process for the acquisition of information intended for the insertion of a locking screw into an orifice of an endomedullary device is described in EP 1 491 151 B1. This document describes a process for the acquisition of information intended for the insertion of a locking screw into a distal locking hole of an endomedullary device. The described process includes taking two images of different orientations of the distal part of the endomedullary device using a radioscopic unit, acquisition of projection parameters, especially the position of the X-ray source and the projection plane of each image by locating a reference frame fixed on the endomedullary device and optionally another reference frame fixed on the radioscopic unit. The process further includes correcting any distortion of the images, segmenting the distal part of the endomedullary device in each image and calculating the attributes relating to the position of the device and to that of the holes, wherein the attributes comprise at least the contours of the device, its centre of gravity and its principal axis. Further, the process includes constructing the projection cone of the distal part of the device for each image, determining the intersection of the two projection cones, modelling of the endomedullary device on the basis of the intersection, determining a centre of a locking hole with the aid of the modelling and of the centres of gravity of the holes determined on the images, determining the orientation of the locking orifice in an iterative manner, and guiding of a drill tool.
U.S. Patent Publication No. 2009/0209851 filed Jan. 9, 2009, titled “STEREOTACTIC COMPUTER ASSISTED SURGERY METHOD AND SYSTEM” discloses a system and method of computer assisted surgery (CAS) using stereotactic navigation with three-dimensional (3D) visualization, and more specifically to a CAS system that is reactive and does not disrupt operating room workflow procedures, the disclosure of which is incorporated herein by reference in its entirety.